2019 CBCRacing Sign-Up and Info Form (2.0)
Please read and complete this document carefully. It contains information on, benefits to, and expectations from you, as a Member of CBCRacing for the following year.
Email address *
alternate email: *
Your answer
First Name *
Your answer
Last Name *
Your answer
Address 1 *
Your answer
Address 2
Your answer
City *
Your answer
State *
Your answer
ZIP *
Your answer
Phone Number (###-###-###): *
Your answer
Can you receive text/SMS messages at this number? *
Gender *
Birth Date (mm/dd/yyyy) *
MM
/
DD
/
YYYY
Emergency Contact: *
Your answer
Relationship to Contact: *
Your answer
Emergency Phone (i.e. ###-###-####): *
Your answer
Are you a new or returning member of CBCRacing? *
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